By Bill Kray
Are you aware of new cholesterol guidelines?
As published on Medscape (login), new guidelines for the detection, evaluation, and treatment of elevated cholesterol were released in November 2013. Cardiologists are still wrapping their heads around the assertion that there is simply no evidence from randomized controlled trials to support treatment to a specific cholesterol target level. Gone are the recommended LDL- and non-HDL cholesterol numbers that ask physicians to treat patients with cardiovascular disease to less than 100 mg/dL or the optional goal of less than 70 mg/dL.
As a result, the new guidelines to prevent atherosclerotic cardiovascular disease (ASCVD) make no recommendations for specific LDL-cholesterol or non-HDL targets for the primary and secondary prevention of atherosclerotic cardiovascular disease. Instead, the guidelines identify 4 groups of primary- and secondary-prevention patients in whom physicians should focus their efforts to reduce cardiovascular disease events. In these 4 patient groups, the new guidelines make recommendations regarding the appropriate "intensity" of statin therapy in order to achieve relative reductions in LDL cholesterol.
- Individuals with clinical ASCVD, including not just people with prior heart attacks, angina, or coronary artery disease resulting in a stent or bypass but also people with atherosclerotic stroke, TIA, or peripheral arterial disease.
- People with primary elevations of LDL-C of 190 mg/dL or greater
- Diabetics 40-75 years old with LDL-C of 70-189 mg/dl
- Individuals, 40-75, without clinical ASCVD or diabetes with a LDL of 70-189 mg/dL, but an estimated absolute 10-year risk of ASCVD (nonfatal MI, CHD death, nonfatal and fatal stroke). The risk should be estimated using what they call Pooled Cohort Equations.
Some Cholesterol is Good for You
In general terms, to reduce dependency on statins, there's good cholesterol you want to raise, called HDL, and bad cholesterol you want to lower, called LDL. Getting the right balance typically involves a detailed combination of exercise and nutrition. Here are a few practical and simple suggestions to get you started.
- Eat More Nuts: Eating two ounces of nuts can increase the ratio of HDL to LDL in the blood by 8.3%. When men replaced 15% of their daily calorie intake with macadamia nuts — 12 to 16 nuts a day — their HDL levels went up by 8 percent in an Australian study.
- Eat Oatmeal Cookies: Men with high LDL cholesterol (above 200 mg/dL) who ate oat-bran cookies daily for eight weeks dropped their levels by more than 20% according to University of Connecticut researchers.
- Become a Part-Time Vegetarian: Men who added a couple of servings of vegetarian food such as whole grains, nuts, and beans to their diets each day for a month lowered their LDL cholesterol by nearly 30% in another study.
These are just three simple diet-based tips of the 15 offered at Prevention.com to improve cholesterol levels. Others include eating grapefruit and concord grapes, building your quadriceps, boosting endurance and drinking cranberry juice.